The Shinyanga Patient: A Patient's Journey through HIV Treatment Cascade in Rural Tanzania

Abstract

The 2016-2017 Tanzania HIV Impact Survey (THIS) reported the accomplishments towards the 90-90-90 global HIV targets at 61-94-87, affirming the need to focus on the first 90 (i.e., getting 90% of people living with HIV (PLHIV) tested). We conducted a patient-pathway analysis to understand the gap observed, by assessing the alignment between where PLHIV seek healthcare and where HIV services are available in the Shinyanga region, Tanzania. We used existing and publicly available data from the National AIDS Control program, national surveys, registries, and relevant national reports. Region-wide, the majority (n = 458/722, 64%) of THIS respondents accessed their last HIV test at public sector facilities. There were 65.9%, 45.1%, and 74.1% who could also access antiretroviral therapy (ART), CD4 testing, and HIV viral load testing at the location of their last HIV test, respectively. In 2019, the viral suppression rate estimated among PLHIV on ART in the Shinyanga region was 91.5%. PLHIV access HIV testing mostly in public health facilities; our research shows that synergies can be achieved to improve access to services further down the cascade in this sector. Furthermore, effective engagement with the private sector (not-for-profit and for-profit) will help to achieve the last mile toward ending the HIV epidemic.

Keywords: HIV; access; health services; patient-pathway analysis; sub-Saharan Africa.

Figure 1

Patient-pathway analysis visual. (a) Number of facilities and place of last HIV test: Estimated number of facilities in each sector and proportion of respondents who had an HIV test within the last 1 year in the 2016–2017 Tanzania HIV Impact Survey (THIS); (b) HIV testing availability: % of facilities or community-based programmes with HIV testing services available obtained from Tanzania Health Facility Registry (HFR) and DHIS2 summary report; (c) HIV testing access: % of THIS respondents who tested for HIV in the public and private sector, by level; Testing availability (d) CD4 count and (f) HIV viral load): % of facilities with HIV diagnostic services (CD4 count and HIV viral load) available as obtained from DHIS2 summary report; Testing access (e) CD4 count and (g) HIV viral load): % of PLHIV who could access HIV diagnostic services at the same facility as their last HIV test by sector and level; (h) Treatment availability: % of facilities where ARV are available as obtained from the Tanzania HFR and DHIS2 summary report; (i) Treatment access: % of PLHIV who could access ART services at the same facility as their last HIV test (by sector and level); (j) Treatment outcome: % of PLHIV who are virally suppressed out of all viral tests done in the region for the second quarter of 2019 from the National AIDS Control Programme HIV data handbook.